|Policy & Procedure Statement
Subject: Premedication for Patients with Complete Joint Replacement
Effective Date: 7/09/14
P&P Number: B.18A
The purpose of this policy is to set guidelines for premedicating dental patients with complete joint replacements that require dental treatment.
This policy adheres to the 2012 American Academy of Orthopaedic Surgeons/American Dental Association guidelines for premedication of patient with total joint replacement.
Per the 2012 AAOS/ADA Clinical Practice Guidelines on prevention of orthopaedic implant infection in patients undergoing dental procedures:
“There is no conclusive evidence that demonstrates a need to routinely administer antibiotics to patients
with an orthopaedic implant who undergo dental procedures.”
“The research showed that invasive dental procedures, with or without antibiotics, did not increase the
odds of developing a prosthetic joint infection.”
“There is no direct evidence that the use of oral topical antimicrobials before dental procedures will
prevent prosthetic joint infection.”
Recommendation from AAOS/ADA Clinical Practice Guidelines:
Practitioners should consider changing the longstanding practice of prescribing prophylactic antibiotics for patients who undergo dental procedures. The recommendation is founded in evidence that dental procedures are unrelated to prosthetic joint infection and that subsequent antibiotic prophylaxis does not reduce the risk for prosthetic joint infection.
There is no direct evidence that oral topical antimicrobials before dental procedures will
prevent prosthetic joint infection.
Maintenance of good hygiene is low cost, provides potential benefit, is consistent with current practice, and is in accordance with good oral health.
The decision regarding any specific procedure or treatment must be made in light of all circumstances presented by the patient, the needs and resources particular to the locality or institution, and clinical judgment of the provider. The following patients may need antibiotic prophylaxis before invasive dental procedures:
Immunocompromised/immunosuppressed patients, Inflammatory arthropathies (e.g.: rheumatoid arthritis, systemic lupus erythematosus), Drug-induced immunosuppression, Radiation-induced immunosuppression, Patients with co-morbidities (e.g.: diabetes, obesity, HIV, smoking), Previous prosthetic joint infections, Malnourishment, Hemophilia, Insulin-dependent (Type 1) diabetes, Malignancy, Megaprostheses.
When in doubt dental providers should consider consulting with the patient’s medical provider.
If the dentist determines that a patient under the 2012 AAOS/ADA guidelines does not require premedication the patient will be advised. If the patient or the patient’s orthopaedic surgeon still request premedication, the patient may be referred back to the surgeon with a reference to the 2012 AAOS/ADA guidelines and if the surgeon still requests premedication the dentist may request the physician prescribe the RX of their choice.
If determined necessary one of these preventive antibiotics may be